Last modified: 2018-09-09
Abstract
Introduction-Autism is a common neurodevelopmental disorder with mean age of diagnosis around four years.Routine screening enables early diagnosis and intervention,and leads to significant improvement.The Modified Checklist for Autism in Toddlers (MCHAT),a commonly used screening test in toddlers is very subjective and relies completely on the parent’s observations.One of the authors observed that SA,a normal developmental milestone is absent/attenuated in autistic children.
Methods-The prospective observational study was conducted in a tertiary child neurology clinic in a large metropolitan Indian city.30 toddlers (1-3 years) with suspected autistic disorder were recruited as cases and 30 age-matched normally developing toddlers as controls after obtaining informed consent.Exclusion criteria were motor disability and secondary causes of autism e.g epileptic encephalopathy.
We devised a separation anxiety score (SAS) modified from Ainsworth’s attachment scale. Higher scores(>/= 3) indicate absent/attenuated SA.Cases classified as “at moderate – high risk” on MCHAT were subjected to SAS.Autism was confirmed by using the Childhood Autism Rating Scale/Autism Diagnostic Interview-Revised.Toddlers who were classified as low risk on the MCHAT were the controls and were subjected to SAS as well.
Results-28/30 cases and 2/30 controls demonstrated absent/attenuated SA (<.0001).The median SAS was 4 for the cases and 2 for the controls.The specificity,sensitivity,positive and negative predictive value of the SAS was 93 % each.Gender,birth order,joint/nuclear family,parents’ education level and socio-economic status did not show any correlation.
Conclusion-The evaluation of SA is a helpful clinical sign in the early diagnosis of autism in toddlers,and can be easily performed in a busy OPD.